Both hyperoxia and mechanical ventilation can independently cause lung injury. In combination, these insults produce accelerated and severe lung injury. We recently reported that pre-exposure to hyperoxia for 12 hours, followed by ventilation with large tidal volumes, induced significant lung injury and epithelial cell apoptosis compared with either stimulus alone. We also reported that such injury and apoptosis are inhibited by antioxidant treatment. In this study, we hypothesized that apoptosis signal-regulating kinase-1 (ASK-1), a redox-sensitive, mitogen-activated protein kinase kinase kinase, plays a role in lung injury and apoptosis in this model. To determine the role of ASK-1 in lung injury, the release of inflammatory mediators and apoptosis, attributable to 12 hours of hyperoxia, were followed by large tidal volume mechanical ventilation with hyperoxia. Wild-type and ASK-1 knockout mice were subjected to hyperoxia (FI O 2 ¼ 0.9) for 12 hours before 4 hours of large tidal mechanical ventilation (tidal volume ¼ 25 ml/g) with hyperoxia, and were compared with nonventilated control mice. Lung injury, apoptosis, and cytokine release were measured. The deletion of ASK-1 significantly inhibited lung injury and apoptosis, but did not affect the release of inflammatory mediators, compared with the wild-type mice. ASK-1 is an important regulator of lung injury and apoptosis in this model. Further study is needed to determine the mechanism of lung injury and apoptosis by ASK-1 and its downstream mediators in the lung.Keywords: ventilator-induced lung injury; acute lung injury; hyperoxia; apoptosis; apoptosis signal-regulating kinase-1 Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are destructive disorders that affect approximately 200,000 patients per year in the United States alone, with mortality as high as 60%. The resulting hypoxemic respiratory failure mandates the use of mechanical ventilation, putting patients at risk for ventilator-induced lung injury (VILI). At least 9% excess mortality has been attributed to VILI in these patients (1). Most patients with ARDS are mechanically ventilated using high concentrations of oxygen (mean FI O 2 on Day 1 ¼ 70%) (2). The most severely ill patients require a much higher FI O 2 (100%) for prolonged periods or for frequent intervals (3). Although both mechanical ventilation and hyperoxia (HO) have been extensively studied, surprisingly little attention has been paid to their potential interaction, despite their near ubiquitous concomitant use. Although high concentrations of oxygen combined with mechanical ventilation are often life-saving, hyperoxia in conjunction with mechanical ventilation can augment lung injury (4-9). We reported that pre-exposure to HO (FI O 2 ¼ 0.9 for 12 hours), followed by large tidal volume mechanical ventilation (HV ¼ 25 ml/g for 4 hours) with HO, caused significant lung injury compared with either stimulus alone or combined HV and HO not preceded by exposure ti HO (7). This severe lung injury was associated with ca...